Provider Demographics
NPI:1003049784
Name:KEIZER HEARING AID CENTER
Entity Type:Organization
Organization Name:KEIZER HEARING AID CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:503-393-2222
Mailing Address - Street 1:5466 RIVER RD N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4483
Mailing Address - Country:US
Mailing Address - Phone:503-393-2222
Mailing Address - Fax:503-393-2723
Practice Address - Street 1:5466 RIVER RD N
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4483
Practice Address - Country:US
Practice Address - Phone:503-393-2222
Practice Address - Fax:503-393-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-428251332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment